The annual out-of-pocket cost to healthcare service consumers for healthcare service appointments is currently on the order of 250 billion dollars and is expected to rise to 420 billion dollars within seven years. This is due, in part, to our aging population and, in part, to many healthcare service consumers being forced to accept healthcare insurance plans with higher co-payments, higher deductibles, and lower coverage ceilings/caps. Consequently, budgeting for out-of-pocket healthcare service costs is becoming an issue for an increasing number of households and individual healthcare service consumers.
However, using current healthcare service appointment scheduling systems, a healthcare service consumer typically is given no indication of how much a healthcare service appointment is likely to cost them at the time they make the healthcare service appointment, at least beyond their minimum co-pay. Consequently, currently, when a healthcare service consumer is making a healthcare service appointment to see their doctor, or to have a follow up procedure/analysis performed, they have no idea how much to budget for the healthcare service appointment and/or follow up procedure/analysis. The result is that many healthcare service consumers are surprised by additional and/or unexpected costs associated with a healthcare service appointment and/or follow up procedure/analysis after the fact, i.e., after going to the healthcare service appointment and/or follow up procedure/analysis, and when it is too late to effectively budget for the appointment and/or follow up procedure/analysis.
In addition, healthcare service providers also suffer from the lack of ability to estimate patient costs at the time the patient is making a healthcare service appointment to see their doctor, or to have a follow up procedure/analysis performed. This is because many healthcare service providers actually collect less than 50% of the payments invoiced to healthcare service consumers for amounts not covered by healthcare insurance providers.
Making the situation even more difficult for healthcare service providers is the fact that the costs associated with generating invoices and collecting payments for healthcare related services and products are among the highest of any industry. As an example, on average, the cost of invoicing and processing healthcare payments is typically 15% or more of the dollar amount spent on the healthcare services themselves. In contrast, the cost of invoicing and processing of payments in the retail industry is typically 2% or less. The vast majority of these invoicing and processing costs in the healthcare industry are concentrated in the 250 billion dollars that healthcare service consumers pay healthcare service providers directly each year, i.e., the out-of-pocket costs the healthcare service consumers must pay beyond the portion that the healthcare insurance providers pay. However, as noted above, despite the high cost of invoicing and processing healthcare payments, many healthcare service providers actually collect less than 50% of the payments invoiced to healthcare service consumers for amounts not covered by healthcare insurance providers. As a result, the healthcare service providers not only incur the onerous invoicing and processing costs, but then, for their efforts, they still have one of the lowest actual collection rates of any industry.
To help alleviate this situation, many healthcare service providers would like to require the patient to pre-pay at least a portion of the expected patient out-of-pocket costs at the time the appointment and/or follow up procedure/analysis is scheduled. However, using current healthcare service appointment scheduling systems, and therefore without an efficient and/or reliable mechanism for estimating patient costs associated with a healthcare service appointment and/or follow up procedure/analysis at the time the healthcare service appointment and/or follow up procedure/analysis is being scheduled, healthcare service providers are typically unable to collect any portion of the expected patient out-of-pocket costs before the appointment and/or follow up procedure/analysis is performed.
In addition, for most healthcare service providers, the key to maximizing efficiency, and income, is to maximize the number of patient appointments for each business day. To this end, most healthcare service providers try to schedule an optimum number of appointments for any given business day well in advance. However, different types of patient symptoms and/or treatments require different amounts of time to address. Consequently, most healthcare service providers would benefit greatly from an ability to accurately estimate the time required for a specific patient appointment. However, using current healthcare service appointment scheduling systems, there is typically little or no accurate correlation between a patient's actual needs, as indicated by, for instance, the patient's symptoms or the patients medical history, with the amount of time allocated to the patient's appointment. As a result, healthcare service providers often either over-book their appointments, which often results in patients having to spend long periods of time in the waiting room, or under-book their appointments, resulting in blocks of “dead-time” during the work day when the healthcare service provider is incurring overhead but generating no income, i.e., when no patients are being seen and/or treated.
As noted above, in the United States, our population is aging and many healthcare service consumers are being forced to accept healthcare insurance plans with higher co-payments, higher deductibles, and lower coverage ceilings/caps. Consequently, both healthcare service consumers and healthcare service providers need more reliable mechanisms for estimating costs and making efficient use of their time. As discussed above, using currently available healthcare service appointment scheduling systems: it is difficult for healthcare service consumers to budget for healthcare service appointments early in the process, i.e., at the time the appointment is being made; it is difficult for healthcare service providers to collect advance payments for services at the time the appointment is being made; and it is difficult for healthcare service providers to efficiently and accurately allocate time for a given patient appointment based on the patient's actual needs. Consequently, currently available healthcare service appointment scheduling systems are less than ideal for both healthcare service consumers and healthcare service providers.